Top 10 inpatient DRG codes
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While there has been a shift in care from hospitals to outpatient facilities (like ambulatory surgery centers), inpatient services still account for about half of a hospital’s patient revenue.
Diagnosis-related groups (DRGs) are used to classify patients and document their hospital stay. Medicare sets a standard amount to pay for each hospital case and adds a payment weight for each DRG. Payment weights are based on several factors, including:
- Case severity
- Geographic location
- Proportion of low-income patients in the hospital’s service area
- Patient age, sex, and comorbidities
What kind of diagnoses are included in DRGs?
A principal diagnosis is established by a physician as the main reason for a patient’s admission to the hospital and governs a patient’s initial course of treatment. Secondary diagnoses are any conditions that exist alongside the principal diagnosis at the time of admission, or that affect a patient’s care after the initial diagnosis.
The Definitive Healthcare HospitalView product tracks Medicare inpatient DRGs for more than 5,200 U.S. hospitals. DRGs are sourced from the Medicare Standard Analytic Files (SAF). Complete calendar year data is typically released each fall for the preceding year.
The tables below review the top DRG codes by principal and secondary diagnoses for January 2022 to June 2022.
Top 10 DRGs by principal diagnoses for 2022
| Rank | DRG code | DRG description | Percent of principal diagnoses |
| 1 | 871 | SEPTICEMIA OR SEVERE SEPSIS W/O MV 96 OR MORE HOURS W MCC | 6.9% |
| 2 | 291 | HEART FAILURE & SHOCK W MCC | 4.4% |
| 3 | 177 | RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC | 4.3% |
| 4 | 885 | PSYCHOSES | 2.7% |
| 5 | 193 | SIMPLE PNEUMONIA & PLEURISY W MCC | 1.5% |
| 6 | 470 | MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC | 1.4% |
| 7 | 189 | PULMONARY EDEMA & RESPIRATORY FAILURE | 1.3% |
| 8 | 872 | SEPTICEMIA OR SEVERE SEPSIS W/O MV 96 OR MORE HOURS W/O MCC | 1.3% |
| 9 | 392 | ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC | 1.2% |
| 10 | 690 | KIDNEY & URINARY TRACT INFECTIONS W/O MCC | 1.1% |
Fig 1. Data from Definitive Healthcare HospitalView product and sourced from the 2022 Medicare Quarterly Standard Analytic Files (SAF) for January 2022 to June 2022. Accessed December 2022.
What is the top DRG by principal diagnosis?
Septicemia, also known as sepsis, DRG code 871 is the top DRG code by principal diagnoses. Sepsis is a severe blood infection that is most often contracted via wound infection. If left untreated, sepsis can lead to organ damage, organ failure, and even death.
Top 10 DRGs by secondary diagnoses for 2022
| Rank | DRG code | DRG description | Percent of secondary diagnoses |
| 1 | 871 | SEPTICEMIA OR SEVERE SEPSIS W/O MV 96 OR MORE HOURS W MCC | 8.5% |
| 2 | 891 | HEART FAILURE & SHOCK W MCC | 5.0% |
| 3 | 177 | RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC | 4.4% |
| 4 | 193 | SIMPLE PNEUMONIA & PLEURISY W MCC | 1.6% |
| 5 | 885 | PSYCHOSES | 1.6% |
| 6 | 189 | PULMONARY EDEMA & RESPIRATORY FAILURE | 1.4% |
| 7 | 872 | SEPTICEMIA OR SEVERE SEPSIS W/O MV 96 OR MORE HOURS W/O MCC | 1.3% |
| 8 | 853 | INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W MCC | 1.3% |
| 9 | 682 | RENAL FAILURE W MCC | 1.3% |
| 10 | 280 | ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC | 1.3% |
Fig 2. Data from Definitive Healthcare HospitalView product and sourced from the 2022 Medicare Quarterly Standard Analytic Files (SAF) for January 2022 to June 2022. Accessed December 2022.
What is the top DRG by secondary diagnosis?
The most common secondary diagnosis is also septicemia DRG code 871. The top three DRGs by principal and secondary diagnoses are the same – sepsis, heart failure, and respiratory infections and inflammations.
Three DRG codes appear on the top principal diagnosis list and not the secondary diagnosis list:
- DRG 392: ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC
- DRG 470: MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC
- DRG 690: KIDNEY & URINARY TRACT INFECTIONS W/O MCC
And the three DRG codes that are in the top secondary diagnosis list and not the principal diagnosis list are:
- DRG 280: ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC
- DRG 682: RENAL FAILURE W MCC
- DRG 853: INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W MCC
The lists may reflect comorbidities or hospital-acquired conditions (HAC). For example, if a patient is admitted to the hospital for joint replacement surgery, they could conceivably contract sepsis while in recovery, which could lead to heart and/or respiratory failure.
How many DRGs are there?
In the Definitive Healthcare HospitalView product, there are 759 DRG codes listed for the January 2022 to June 2022 timeframe.
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